Seniors
The American Red Cross recommends that senior citizens create a personal support network made up of several individuals who will check in on them in an emergency to ensure their wellness and to give assistance if needed. This network can consist of friends, roommates, family members, relatives, personal attendants, co-workers and neighbors. It is suggested that a minimum of three people are identified at each location where one regularly spends a significant part of their week, for example; at work, home, school or volunteer site.
There are seven important items to discuss, give to and practice with a personal support network:
* Make arrangements, prior to an emergency, for your support network to immediately check on you after a disaster and, if needed, offer assistance.
* Exchange important keys.
* Show where you keep emergency supplies.
* Share copies of your relevant emergency documents, evacuation plans and emergency health information card.
* Agree and practice a communications system regarding how to contact each other in an emergency. Do not count on the telephones working.
* You and your personal support network should always notify each other when you are going out of town and when you will return.
* The relationship should be mutual. Learn about each other's needs and how to help each other in an emergency. You could be responsible for food supplies and preparation, organizing neighborhood watch meetings and interpreting, among other things. For emergency supplies see www.emergencyprepstore.com.
Monday
Hourly and Live-in Care Services and Rates
Hourly and Live-in Care Services and Rates
Senior Home Care Agencies offer hourly care and live-in care. There are a few agencies who only offer hourly care as live-in care requires a different staff and more management.
Hourly Care
Usually a minimum of 3 to 4 hours of care per visit are required to begin hourly care services. Many agencies will begin services with one visit per week, knowing that seniors are sometimes resistant to start care. Typically a senior who is resistant to care will be open to more hours of service once they experience the benefits of a Caregiver’s visits. Senior Home Care Agencies will ask clients to commit to a regularly weekly schedule, in order to staff a qualified, consistent Caregiver. It is acceptable to change the hours after your initial start-up, as often the real needs are exposed after the Caregiver has started services. The agency will also ask if you would like a substitute Caregiver to provide services if your Caregiver is unable to fulfill an assigned shift. Some clients prefer their regular Caregiver to change hours when they need off, rather than to have a substitute Caregiver. Some Agencies will send Care Managers or Field Supervisors to introduce the substitute Caregiver. Most Agencies will have a Care Manager or Field Supervisor introduce and train the Caregiver on the first visit.
Hourly Care Overview
* Minimum Hours per Visit: Usually 3 to 4 hours
* Industry avg Cost: $16 - $25 per hour (varies in geographic areas, most metropolitan cities charge $18+ per hour)
* Schedule: Regular schedule required to staff consistent Caregiver, acceptable to change schedule
* Payment: Two-week deposit may be required; Agencies bill weekly or every other week
* Benefit of Hourly Care: Agency responsible to make sure a Caregiver is always there at scheduled time
Connect with Senior Home Caregivers to learn about the best services and pricing in the industry.
Live-in Care
Seniors who need someone to be with them around-the-clock, but are able to allow the Caregiver to adequately sleep at night, will require a live-in Caregiver. Live-in Caregivers work a few days at a time and are paid a daily salary, not an hourly rate. The Caregiver does not actually “live” with the senior, but will go to their own home between shifts. Typically a team of two Caregivers will rotate days to provide the client with a consistent team. The client is required to provide food for the Caregiver and a place for them to sleep. Usually a food delivery service is used or a family member of Care Manager will provide grocery shopping services. If Hospice is involved in the care, they will work with the live-in Caregiver to provide training. It is important for the senior client to be comfortable with someone sharing their home. If the client’s medical condition changes and they need the Caregiver to regularly be up with them at night, then it will be necessary to switch to around-the-clock hourly care.
Live-in Care Overview
* Industry avg Cost: $180 - $250 per day
* Schedule: Minimum of two Caregivers will rotate days
* Payment: Two-week deposit may be required; Agencies bill weekly or every other week
* Benefits of Live-in Care: For nearly the same cost as a nursing home, a client receives one-on-one care from a devoted Caregiver and is able to remain in their own home
Connect with Senior Home Caregivers learn about the best services and pricing in the industry.
Medicare Coverage
Medicare does not pay for long-term care in the home. Medicare will pay for a short-term stay in a nursing home (up to 100 days, with medical doctor approval). Medicare will pay for “Skilled Care” home visits which includes a Registered Nurse (R.N.), Speech Therapist (S.T.), Physical Therapist (P.T.), Occupational Therapist (O.T.). These skilled professionals are preapproved for visits by a medical doctor and will make hourly visits to the home to provide their care services. Medicare Home Care Agencies provide these services and most medical doctors and hospitals have relationships with one or two Medicare Home Care Agencies. Some hospitals own their own Medicare agency. If these services are required, typically the doctor approves the service upon discharge from the hospital or nursing home.
Senior Home Care Agencies offer hourly care and live-in care. There are a few agencies who only offer hourly care as live-in care requires a different staff and more management.
Hourly Care
Usually a minimum of 3 to 4 hours of care per visit are required to begin hourly care services. Many agencies will begin services with one visit per week, knowing that seniors are sometimes resistant to start care. Typically a senior who is resistant to care will be open to more hours of service once they experience the benefits of a Caregiver’s visits. Senior Home Care Agencies will ask clients to commit to a regularly weekly schedule, in order to staff a qualified, consistent Caregiver. It is acceptable to change the hours after your initial start-up, as often the real needs are exposed after the Caregiver has started services. The agency will also ask if you would like a substitute Caregiver to provide services if your Caregiver is unable to fulfill an assigned shift. Some clients prefer their regular Caregiver to change hours when they need off, rather than to have a substitute Caregiver. Some Agencies will send Care Managers or Field Supervisors to introduce the substitute Caregiver. Most Agencies will have a Care Manager or Field Supervisor introduce and train the Caregiver on the first visit.
Hourly Care Overview
* Minimum Hours per Visit: Usually 3 to 4 hours
* Industry avg Cost: $16 - $25 per hour (varies in geographic areas, most metropolitan cities charge $18+ per hour)
* Schedule: Regular schedule required to staff consistent Caregiver, acceptable to change schedule
* Payment: Two-week deposit may be required; Agencies bill weekly or every other week
* Benefit of Hourly Care: Agency responsible to make sure a Caregiver is always there at scheduled time
Connect with Senior Home Caregivers to learn about the best services and pricing in the industry.
Live-in Care
Seniors who need someone to be with them around-the-clock, but are able to allow the Caregiver to adequately sleep at night, will require a live-in Caregiver. Live-in Caregivers work a few days at a time and are paid a daily salary, not an hourly rate. The Caregiver does not actually “live” with the senior, but will go to their own home between shifts. Typically a team of two Caregivers will rotate days to provide the client with a consistent team. The client is required to provide food for the Caregiver and a place for them to sleep. Usually a food delivery service is used or a family member of Care Manager will provide grocery shopping services. If Hospice is involved in the care, they will work with the live-in Caregiver to provide training. It is important for the senior client to be comfortable with someone sharing their home. If the client’s medical condition changes and they need the Caregiver to regularly be up with them at night, then it will be necessary to switch to around-the-clock hourly care.
Live-in Care Overview
* Industry avg Cost: $180 - $250 per day
* Schedule: Minimum of two Caregivers will rotate days
* Payment: Two-week deposit may be required; Agencies bill weekly or every other week
* Benefits of Live-in Care: For nearly the same cost as a nursing home, a client receives one-on-one care from a devoted Caregiver and is able to remain in their own home
Connect with Senior Home Caregivers learn about the best services and pricing in the industry.
Medicare Coverage
Medicare does not pay for long-term care in the home. Medicare will pay for a short-term stay in a nursing home (up to 100 days, with medical doctor approval). Medicare will pay for “Skilled Care” home visits which includes a Registered Nurse (R.N.), Speech Therapist (S.T.), Physical Therapist (P.T.), Occupational Therapist (O.T.). These skilled professionals are preapproved for visits by a medical doctor and will make hourly visits to the home to provide their care services. Medicare Home Care Agencies provide these services and most medical doctors and hospitals have relationships with one or two Medicare Home Care Agencies. Some hospitals own their own Medicare agency. If these services are required, typically the doctor approves the service upon discharge from the hospital or nursing home.
Thursday
Home Health Agency Care
Home Health Agency Care
DESCRIPTION:
In the year 2000, about 12,800 home health agencies served approximately 8,600,000 clients across the United States . In that year Medicare paid an estimated 85% to 90% of the total cost of home health agency services amounting to $ 8,700,000,000. Although current figures are not yet available, the number of home health agencies has been going up year after year as well as the number of clients being served.
Although home health agencies are privately owned, Medicare is the principle payer for their services. Home health services through Medicare are available under parts A and B. In order to qualify for Medicare homecare a person must have a skilled need, must be homebound and there must be a plan of care ordered by a Physician.
Prior to 1997 Medicare typically paid for home care for as long as it was needed. Prior to 1997 annual Medicare costs were almost double the amount cited above. In order to save money Medicare has since gone to a prospective payment system where, according to the plan of care, a certain amount of money is allocated to resolve the skilled need for the patient.
Monies are typically provided for a period of up to 60 days. If the patient recovers sooner then money may have to be reshuffled to other patients who are not responding as well. At the point where the patient does not respond or improve, no more Medicare money is forthcoming. After Medicare cuts off, a person continuing to need long-term care services must find sources other than Medicare.
Home health agencies deliver a variety of skilled services outlined by the chart below. The plan of care always includes as well custodial services to help the care-recipient remain in the home. These would include an aide for an hour or two a day to help with bathing, dressing and transferring. If there is time remaining other personal services may be offered as well. These personal services are also covered by Medicare.
Recently Medicare has redefined what it means by "homebound" to allow recipients to leave the home on a limited basis. Beginning in 2003 and ending three years later, Medicare is testing, with a very small test group, a program where selected home health agencies can provide adult day health care instead of home health services. If successful the program will offer a new dimension in Medicare home care. In addition, under the new definition, Medicare will also allow and pay for home visits from doctors who specialize in homebound elderly patients. Limited office visits are also allowed under the new definition.
Finally, in the past few years Medicare is paying for home telehealth visits through a home telehealth, computer work station. Telehealth is being used with some success to provide home care in rural areas where it would be difficult to arrange the personal visit from a home health care agency.
LENGTH-OF-STAY:
Although Medicare- will authorize up to 60 days at a time of home care, according to the Centers For Medicare And Medicaid Services (CMS) the average length of stay for Medicare home care services is 41.5 days. Oftentimes a person continues to need supervision or care after Medicare quits paying but the payment for that will have to come from someone other than Medicare.
The number of home care patients as a percent of all individuals in that age group goes up drastically with age. Even though the age group of 85 and above represents only 4% of all the aged population it accounts for about 28% of all patients. The bulk of the aged population is between the ages of 65 to 75 but only accounts for about 27% of all home care patients. Total patients for the aged over age 75 account for the other 73%.
A common statement from individuals who are confronted with the need for long-term care planning is,
"I'm in good health, I'm going to live a long time and I won't need long-term care."
The statistics show otherwise. In fact it is estimated that about half of the population over age 85 is receiving long-term care.
COST:
Since about 90% of all home health agency care is paid for by Medicare or Medicaid, the cost of care is not necessarily relevant for this study. But some families do pay for this service out of their own pockets. Costs will vary from area to area. A nurse, therapist or social worker may cost $70.00 to $100.00 an hour. An aide to take care of daily living needs, so called activities of daily living, are much more affordable. Call Senior Home Caregivers for info about pricing, 888-951-7787.
WHO PAYS?
Medicare and Medicaid pay 90% of the cost of home health agencies services. The other 10% is shared by families, and private insurance. As more people buy long-term care insurance, they will also be more prone to utilize the services of home health agencies. However, this is only after Medicare has paid its portion. This is because all long-term care insurance policies will only pay after Medicare has paid its obligation.
A new trend for home health care is for agencies to furnish care through a cadre of non skilled employees for families who do not qualify for Medicare or Medicaid homecare but still need help with loved ones at home. The future trend will be for more and more of the cost of home care services to be paid by the family or by insurance if it is available.
DESCRIPTION:
In the year 2000, about 12,800 home health agencies served approximately 8,600,000 clients across the United States . In that year Medicare paid an estimated 85% to 90% of the total cost of home health agency services amounting to $ 8,700,000,000. Although current figures are not yet available, the number of home health agencies has been going up year after year as well as the number of clients being served.
Although home health agencies are privately owned, Medicare is the principle payer for their services. Home health services through Medicare are available under parts A and B. In order to qualify for Medicare homecare a person must have a skilled need, must be homebound and there must be a plan of care ordered by a Physician.
Prior to 1997 Medicare typically paid for home care for as long as it was needed. Prior to 1997 annual Medicare costs were almost double the amount cited above. In order to save money Medicare has since gone to a prospective payment system where, according to the plan of care, a certain amount of money is allocated to resolve the skilled need for the patient.
Monies are typically provided for a period of up to 60 days. If the patient recovers sooner then money may have to be reshuffled to other patients who are not responding as well. At the point where the patient does not respond or improve, no more Medicare money is forthcoming. After Medicare cuts off, a person continuing to need long-term care services must find sources other than Medicare.
Home health agencies deliver a variety of skilled services outlined by the chart below. The plan of care always includes as well custodial services to help the care-recipient remain in the home. These would include an aide for an hour or two a day to help with bathing, dressing and transferring. If there is time remaining other personal services may be offered as well. These personal services are also covered by Medicare.
Recently Medicare has redefined what it means by "homebound" to allow recipients to leave the home on a limited basis. Beginning in 2003 and ending three years later, Medicare is testing, with a very small test group, a program where selected home health agencies can provide adult day health care instead of home health services. If successful the program will offer a new dimension in Medicare home care. In addition, under the new definition, Medicare will also allow and pay for home visits from doctors who specialize in homebound elderly patients. Limited office visits are also allowed under the new definition.
Finally, in the past few years Medicare is paying for home telehealth visits through a home telehealth, computer work station. Telehealth is being used with some success to provide home care in rural areas where it would be difficult to arrange the personal visit from a home health care agency.
LENGTH-OF-STAY:
Although Medicare- will authorize up to 60 days at a time of home care, according to the Centers For Medicare And Medicaid Services (CMS) the average length of stay for Medicare home care services is 41.5 days. Oftentimes a person continues to need supervision or care after Medicare quits paying but the payment for that will have to come from someone other than Medicare.
The number of home care patients as a percent of all individuals in that age group goes up drastically with age. Even though the age group of 85 and above represents only 4% of all the aged population it accounts for about 28% of all patients. The bulk of the aged population is between the ages of 65 to 75 but only accounts for about 27% of all home care patients. Total patients for the aged over age 75 account for the other 73%.
A common statement from individuals who are confronted with the need for long-term care planning is,
"I'm in good health, I'm going to live a long time and I won't need long-term care."
The statistics show otherwise. In fact it is estimated that about half of the population over age 85 is receiving long-term care.
COST:
Since about 90% of all home health agency care is paid for by Medicare or Medicaid, the cost of care is not necessarily relevant for this study. But some families do pay for this service out of their own pockets. Costs will vary from area to area. A nurse, therapist or social worker may cost $70.00 to $100.00 an hour. An aide to take care of daily living needs, so called activities of daily living, are much more affordable. Call Senior Home Caregivers for info about pricing, 888-951-7787.
WHO PAYS?
Medicare and Medicaid pay 90% of the cost of home health agencies services. The other 10% is shared by families, and private insurance. As more people buy long-term care insurance, they will also be more prone to utilize the services of home health agencies. However, this is only after Medicare has paid its portion. This is because all long-term care insurance policies will only pay after Medicare has paid its obligation.
A new trend for home health care is for agencies to furnish care through a cadre of non skilled employees for families who do not qualify for Medicare or Medicaid homecare but still need help with loved ones at home. The future trend will be for more and more of the cost of home care services to be paid by the family or by insurance if it is available.
Hospice Care
Hospice Care
It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital or nursing home may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.
When someone is dying but there really is no hope for recovery, the family often calls 911 and starts a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital or nursing home in a strange environment, frightened and confused and tied to tubes and monitoring devices. This is not the ideal way in which to spend one's last hours on earth.
Attending to a dying loved one in the peace and quiet of the home with caring children and grandchildren surrounding the bed can be a spiritual experience for all involved. Hospice can allow this to happen. Memories of a loved one passing in peace can provide great comfort for family members in years to come.
When there is no longer hope for prolonging life, especially when this decision is made months in advance, hospice is a better alternative to other medical intervention.
Hospice is a form of medically supportive care for patients who are terminally ill. It allows for compassion and dignity in the process of dying. A commonly used definition for terminally ill patients is,
"patients who have a progressive, incurable illness that will end in death despite good treatment, and who are sick enough that you would not be surprised if they died within six months."
Hospice care is a valuable service and is generally underused except for terminal cancer patients. Most families wait too long to have their doctor prescribe hospice from Medicare. Many doctors or family don't often consider this care alternative for Alzheimer's, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.
Hospice involves a team approach using the following providers.
-Family caregivers;
-The patient' s personal physician;
-Hospice physician (or medical director);
-Nurses;
-Home health aides;
-Social workers;
-Clergy or other counselors;
-Trained volunteers; and
-Speech, physical, and occupational therapists, if needed.
The purpose of hospice is the following:
-Manages the patient's pain and symptoms;
-Assists the patient with the emotional and psychosocial and spiritual aspects of dying;
-Provides needed medications, medical supplies, and equipment;
-Coaches the family on how to care for the patient;
-Delivers special services like speech and physical therapy when needed;
-Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
-Provides bereavement care and counseling to surviving family and friends.
A person can receive hospice from Medicare if he or she is
-eligible for Medicare Part A (Hospital Insurance), and
-the doctor and the hospice medical director certify that the person is terminally ill and probably has less than six months to live, and
-the person or a family member signs a statement choosing hospice care instead of routine Medicare covered benefits for the terminal illness, and
-care is received from a Medicare-approved hospice program.
A person may continue to receive regular Medicare benefits from his or her customary doctors for conditions not related to the hospice condition.
It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital or nursing home may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.
When someone is dying but there really is no hope for recovery, the family often calls 911 and starts a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital or nursing home in a strange environment, frightened and confused and tied to tubes and monitoring devices. This is not the ideal way in which to spend one's last hours on earth.
Attending to a dying loved one in the peace and quiet of the home with caring children and grandchildren surrounding the bed can be a spiritual experience for all involved. Hospice can allow this to happen. Memories of a loved one passing in peace can provide great comfort for family members in years to come.
When there is no longer hope for prolonging life, especially when this decision is made months in advance, hospice is a better alternative to other medical intervention.
Hospice is a form of medically supportive care for patients who are terminally ill. It allows for compassion and dignity in the process of dying. A commonly used definition for terminally ill patients is,
"patients who have a progressive, incurable illness that will end in death despite good treatment, and who are sick enough that you would not be surprised if they died within six months."
Hospice care is a valuable service and is generally underused except for terminal cancer patients. Most families wait too long to have their doctor prescribe hospice from Medicare. Many doctors or family don't often consider this care alternative for Alzheimer's, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.
Hospice involves a team approach using the following providers.
-Family caregivers;
-The patient' s personal physician;
-Hospice physician (or medical director);
-Nurses;
-Home health aides;
-Social workers;
-Clergy or other counselors;
-Trained volunteers; and
-Speech, physical, and occupational therapists, if needed.
The purpose of hospice is the following:
-Manages the patient's pain and symptoms;
-Assists the patient with the emotional and psychosocial and spiritual aspects of dying;
-Provides needed medications, medical supplies, and equipment;
-Coaches the family on how to care for the patient;
-Delivers special services like speech and physical therapy when needed;
-Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
-Provides bereavement care and counseling to surviving family and friends.
A person can receive hospice from Medicare if he or she is
-eligible for Medicare Part A (Hospital Insurance), and
-the doctor and the hospice medical director certify that the person is terminally ill and probably has less than six months to live, and
-the person or a family member signs a statement choosing hospice care instead of routine Medicare covered benefits for the terminal illness, and
-care is received from a Medicare-approved hospice program.
A person may continue to receive regular Medicare benefits from his or her customary doctors for conditions not related to the hospice condition.
Helping Your Older Parents Stay Happy and Healthy
Helping Your Older Parents Stay Happy and Healthy
by Robert Stall MD, Geriatrician
If you're fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who's driving her to her medical appointments. Perhaps you've become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.
Whatever the case, it's natural to feel challenged – and, yes, intimidated – in the role you've undertaken. But if you stay positive and proactive, you'll be in a great position to advocate for your parents' optimal care. And, really, what better way is there to say "Thank You" for all they've done for you over the years?
The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help.
1. Stay vigilant to sudden changes.
Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or perhaps, a heart attack or stroke.
If you pay attention to your parent's baseline health and behavior, you'll be alert to sudden, and subtle, fluctuations. Being attuned to what's “normal” for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.
2. Investigate the source of gradual decline.
Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking.
After performing a brief procedure on her, I asked how she was doing. “I'm OK,” she replied.
A miracle? Not exactly. I'd removed bullet-sized pieces of wax from her ears. She'd stopped speaking because her ears were too plugged to hear.
A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer's disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson's disease or depression, to name a few.
When discussing your parent's decline with her physician, make sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you've noticed these changes. That way, you won't leave anything out. To help you, I've created a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the “Test Result Details” at the bottom of the page to analyze your responses and give you advice based on your answers.
3. Know thy parent's medicine cabinet.
Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it's potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications' efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com .
4. Discourage ageist attitudes.
Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person's self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent:
“What do you expect at your age?”
“You're not getting any younger.”
If you're ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she's depressed, it may have nothing to do with the fact that she's 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can't be just from age if there's no problem with her left knee. (More about Dr. Stall and a more in-depth article on the attitude of society towards medical care for the elderly can be found at http://www.longtermcarelink.net/eldercare/medical_care_issues.htm )
5. Address not just symptoms—but emotions, too.
There is disease and then there is “dis-ease” – that is, a lack of ease, security or well-being. “Dis-ease” can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.
Take the case of a parent who's incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.
6. Strive to maximize your parent's quality of life.
No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient's functional ability are the cardinal goals of geriatric care. But you don't need a medical diploma on your wall to help your parent achieve either of those goals.
Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more important to him than how much longer he lives. And he doesn't necessarily need medications or surgery to ensure that he's living the latter part of his life to the fullest.
If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he's grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he's living in a nursing home, bring your kids there to share a meal with him.
Sometimes, it's the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.
by Robert Stall MD, Geriatrician
If you're fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who's driving her to her medical appointments. Perhaps you've become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.
Whatever the case, it's natural to feel challenged – and, yes, intimidated – in the role you've undertaken. But if you stay positive and proactive, you'll be in a great position to advocate for your parents' optimal care. And, really, what better way is there to say "Thank You" for all they've done for you over the years?
The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help.
1. Stay vigilant to sudden changes.
Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or perhaps, a heart attack or stroke.
If you pay attention to your parent's baseline health and behavior, you'll be alert to sudden, and subtle, fluctuations. Being attuned to what's “normal” for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.
2. Investigate the source of gradual decline.
Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking.
After performing a brief procedure on her, I asked how she was doing. “I'm OK,” she replied.
A miracle? Not exactly. I'd removed bullet-sized pieces of wax from her ears. She'd stopped speaking because her ears were too plugged to hear.
A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer's disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson's disease or depression, to name a few.
When discussing your parent's decline with her physician, make sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you've noticed these changes. That way, you won't leave anything out. To help you, I've created a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the “Test Result Details” at the bottom of the page to analyze your responses and give you advice based on your answers.
3. Know thy parent's medicine cabinet.
Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it's potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications' efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com .
4. Discourage ageist attitudes.
Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person's self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent:
“What do you expect at your age?”
“You're not getting any younger.”
If you're ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she's depressed, it may have nothing to do with the fact that she's 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can't be just from age if there's no problem with her left knee. (More about Dr. Stall and a more in-depth article on the attitude of society towards medical care for the elderly can be found at http://www.longtermcarelink.net/eldercare/medical_care_issues.htm )
5. Address not just symptoms—but emotions, too.
There is disease and then there is “dis-ease” – that is, a lack of ease, security or well-being. “Dis-ease” can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.
Take the case of a parent who's incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.
6. Strive to maximize your parent's quality of life.
No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient's functional ability are the cardinal goals of geriatric care. But you don't need a medical diploma on your wall to help your parent achieve either of those goals.
Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more important to him than how much longer he lives. And he doesn't necessarily need medications or surgery to ensure that he's living the latter part of his life to the fullest.
If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he's grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he's living in a nursing home, bring your kids there to share a meal with him.
Sometimes, it's the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.
Why Work With an Agency
Hiring Private Duty Home Care Workers:
Why Work through an Agency?
By Rona S. Bartelstone, LCSW, BCD, CMC
One of the greatest long-term needs of older adults and those with chronic illnesses is for in-home, custodial care services. These workers are often referred to as home health aides, certified nursing assistants and custodial care workers. These in-home workers make it possible for people with functional limitations to remain at home in a comfortable, familiar environment. Home health aides (as we will refer to this class of workers) provide a wide range of assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, assisting with ambulation or transferring, toileting, feeding and providing medication reminders. In addition, home health aides help with what professionals call, instrumental activities of daily living (IADLs), such as shopping, meal preparation, making medical appointments, transportation, laundry and companionship.
While it is true that most people would prefer to remain in their own homes, there are circumstances in which care in a residential or nursing facility is more appropriate and more cost-effective. For example, the individual who needs round the clock care because of treatments or behavioral issues will find a nursing facility or residential setting likely to be more affordable. The biggest proportion of people who utilize home health aide services are those who need several hours per day of assistance, as opposed to those who need full-time care.
Due to the cost and the increasing shortage of home health aides, many families seeking to hire in-home staff turn to private individuals rather than working through an agency. While at first glance this seems reasonable, it can also cause numerous problems and create unexpected liabilities for the family, who becomes the employer.
Tax Issues
As a private employer, the individual or family is required to pay Social Security, unemployment and payroll taxes. Many home health aides will represent themselves as independent contractors, ostensibly relieving the hiring individual of these tax obligations. However, it is the responsibility of the hiring individual to be sure that the aide truly is an independent contractor and is therefore paying their own taxes. In many instances, the aide will not meet the legal criteria as an independent contractor. If the aide has not met his or her tax obligations, this responsibility falls to the employer. This can be a serious obligation because it may involve interest on back taxes, civil fines and the possibility of criminal penalties. Potential private employers should seek the advice of a labor lawyer to assure appropriate hiring practices with respect to federal tax laws.
Case Example: Mr. L hired a home health aide for his mother on the basis of a recommendation from a neighbor who also employed this individual. Mrs. L needed help because of a minor stroke that left her unsteady on her feet. Initially, Mrs. L only needed four hours of help per day to assure that she had a bath, that two meals were prepared and that the weekly shopping was completed. Occasionally, the aide also accompanied Mrs. L to some of her many medical appointments.
As time went on, Mrs. L continued to have minor strokes that left her increasingly debilitated. After 18 months, Mrs. L was quite incapacitated and had lost her ability to speak. At that point, the family decided to ask the aide to live in full-time and provide total care to Mrs. L. This relationship was very loving and lasted until Mrs. L passed away.
Because the aide had given up all of her other clients to care for Mrs. L full-time, she had no other immediate employment when Mrs. L died. Since she needed income to support her family, the aide filed for unemployment benefits. It was at that point, that the IRS became aware of the employer and filed a lawsuit for back unemployment taxes, penalties and a fine. The family of Mrs. L did not understand their responsibility as an employer and found themselves in a legal action that took over two years and many thousands of dollars to resolve.
Workers' Compensation and Liability Issues
As the employer, the individual or family paying for the private home health aide would be held liable for any work-related injury that occurs on the job. This can include the cost of all medical expenses and any disability payments that might become applicable.
Since the home-care industry is noted for work-related injuries, this can be a huge risk, especially if the caregiving tasks include lifting, transferring or bathing. There are also risks related to communicable diseases if the aide does not abide by universal precautions that are required by all licensed agency personnel.
Furthermore, the employer retains any liability that arises out of an injury to the person being cared for or any other person on the premises. If the home health aide were to cause an accident, for example, in which other family members suffered any harm or losses, the employer would bear the full responsibility for all costs and compensation.
Case Example: Home health aide, Myra Jones had a history of back injuries after many years of work in rehabilitation facilities. Her injuries always responded well to treatment, and were kept at bay with back supports provided by her employer. When Mrs. Jones had the opportunity to follow one of her clients home from rehab as a private aide, she took advantage of the offer and worked privately for Mr. S.
Mr. S didn't need a lot of physical care when he first left the rehab facility. He was there because he had had surgery that left him weak and a little confused. Unfortunately, the confusion did not clear up as the anesthesia left his body. It seemed that he had begun to develop a dementing illness, and would need increasing supervision for safety.
Over time, Mr. S began to need increasing amounts of physical care, especially for transferring and dressing. Mrs. Jones found herself increasingly taxed by the care of Mr. S, but she had become so attached to him that she did not express her concerns to the family that had hired her.
One day, as Mrs. Jones was dressing Mr. S, she bent down to help him with his shoes and her back froze in place. She was unable to straighten up. She managed to creep to the phone to call a friend for help, but she had to insist that Mr. S not move out of her sight for fear that he would wander off.
Mrs. Jones had found herself being treated in the rehabilitation facility in which she used to work. The doctor told her that she would not be able to work as an aide again. As she got stronger, Mrs. Jones filed for worker's compensation and disability insurance.
Once again, the government became aware of the employment situation in which the injury occurred and they pursued the family for medical expenses and for disability coverage. This cost the family many times more than it would have if they had the appropriate insurances or if they had worked through a licensed home health agency.
Abuse and Exploitation
Unfortunately, there is the potential for both physical abuse and financial exploitation when work is being done on behalf of a frail, functionally limited, and often cognitively impaired individual. While most individuals who become home health aides do so out of a desire to help others and to contribute to the community, there will always be those who see this type of work as an opportunity to take advantage of someone. This becomes especially easy when the aide and the recipient of care are isolated in a private home setting with little or no supervision.
Families don't fail to provide supervision out of malicious neglect. Supervision is often difficult because of geographic distance, lack of expertise, or the close emotional bonds that often get established between the aide and the person receiving the care. Furthermore, families often do not have the time or the resources to do criminal background checks, or to contact references, if they even think to ask for references. Sometimes families are so grateful for the care provided by an aide that they are also vulnerable to manipulation and exploitation.
Agency Supervision
A licensed home care agency has a responsibility to provide ongoing supervision for their employees. This includes helping the aides to understand the changing needs of clients, assuring the proper limits of care according to the practice acts of the various levels of professionals, and mediating difficult relationship issues.
Providing supervision is often as important for the aide as it is for the family. Home health aides often work with very challenging situations in the isolation of the private home situation. There are often issues of different cultural and faith traditions, different expectations about personal schedules, eating preferences and expectations. An agency supervisor can help to clarify the roles of the home health aide, and the expectations of both worker and care recipient. Furthermore, the agency can support the aide in setting appropriate limits on the types of care that can be provided. For example, an older adult might expect an aide to help with dressing changes or high tech care that is legally the responsibility of a licensed nurse.
In situations in which there are personality issues because of cognitive changes or a history of challenging relationships, the agency supervisor is available to provide guidance and support to both staff and care recipient. This can be very fragile, especially if there is a lack of trust or behaviors that are strange to the home health aide. The support of a supervisor can help the aide understand that this is part of the disease process and cope with behaviors so that the aide and the client can have a successful relationship. Often, supportive supervision is the key to making a challenging situation work.
Case Example: Mr. B lost his wife who had cared for him for over 60 years. He needed help with shopping, meal preparation, transportation and an appropriate selection of clothing. His family had hired many aides on his behalf. It seemed that Mr. B would fire every aide after only a few days, always stating that they didn't know how to do anything right. When Mr. B came to us, the home health supervising nurse spent time talking with him about his needs and expectations.
She learned that Mr. B was unhappy because none of the aides did things the way his wife had done them and this made him feel uncomfortable in his own home. The nurse supervisor explained that everyone had different ways of keeping house. Mr. B was amazed because he thought that all women learned the same routines. Having realized this, the nurse spent more time with Mr. B to find out what was happening that was different from what his wife had done. Amazingly, small things like letting dishes air dry on the counter, versus drying them and putting them away, were distressing to him. By going through the daily routine and learning about Mr. B's expectations, the supervisor was able to provide clarification to the aide and the first one placed in the home was able to be successful and have a multi-year relationship with Mr. B.
The employer, whether it is a private individual or an agency, has a great deal of responsibility in hiring and managing a home health aide. This includes responsibilities that are financial, legal and involve governmental regulations. When a family is ready to hire home health aide services, they need to make a basic decision about the source of such assistance. This decision needs to take into consideration the type of help needed, the financial and tax implications, the need for supervision and the relative vulnerability of the person receiving the care.
If the family is unwilling or unable to assume the full range of responsibilities, they would be better off working through an agency. If the family chooses to hire privately, they need to consult a lawyer and an accountant to assure that they make proper arrangements for all of their obligations. In addition, they need to stay involved in the relationship to assure proper care and a mutually supportive relationship.
Why Work through an Agency?
By Rona S. Bartelstone, LCSW, BCD, CMC
One of the greatest long-term needs of older adults and those with chronic illnesses is for in-home, custodial care services. These workers are often referred to as home health aides, certified nursing assistants and custodial care workers. These in-home workers make it possible for people with functional limitations to remain at home in a comfortable, familiar environment. Home health aides (as we will refer to this class of workers) provide a wide range of assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, assisting with ambulation or transferring, toileting, feeding and providing medication reminders. In addition, home health aides help with what professionals call, instrumental activities of daily living (IADLs), such as shopping, meal preparation, making medical appointments, transportation, laundry and companionship.
While it is true that most people would prefer to remain in their own homes, there are circumstances in which care in a residential or nursing facility is more appropriate and more cost-effective. For example, the individual who needs round the clock care because of treatments or behavioral issues will find a nursing facility or residential setting likely to be more affordable. The biggest proportion of people who utilize home health aide services are those who need several hours per day of assistance, as opposed to those who need full-time care.
Due to the cost and the increasing shortage of home health aides, many families seeking to hire in-home staff turn to private individuals rather than working through an agency. While at first glance this seems reasonable, it can also cause numerous problems and create unexpected liabilities for the family, who becomes the employer.
Tax Issues
As a private employer, the individual or family is required to pay Social Security, unemployment and payroll taxes. Many home health aides will represent themselves as independent contractors, ostensibly relieving the hiring individual of these tax obligations. However, it is the responsibility of the hiring individual to be sure that the aide truly is an independent contractor and is therefore paying their own taxes. In many instances, the aide will not meet the legal criteria as an independent contractor. If the aide has not met his or her tax obligations, this responsibility falls to the employer. This can be a serious obligation because it may involve interest on back taxes, civil fines and the possibility of criminal penalties. Potential private employers should seek the advice of a labor lawyer to assure appropriate hiring practices with respect to federal tax laws.
Case Example: Mr. L hired a home health aide for his mother on the basis of a recommendation from a neighbor who also employed this individual. Mrs. L needed help because of a minor stroke that left her unsteady on her feet. Initially, Mrs. L only needed four hours of help per day to assure that she had a bath, that two meals were prepared and that the weekly shopping was completed. Occasionally, the aide also accompanied Mrs. L to some of her many medical appointments.
As time went on, Mrs. L continued to have minor strokes that left her increasingly debilitated. After 18 months, Mrs. L was quite incapacitated and had lost her ability to speak. At that point, the family decided to ask the aide to live in full-time and provide total care to Mrs. L. This relationship was very loving and lasted until Mrs. L passed away.
Because the aide had given up all of her other clients to care for Mrs. L full-time, she had no other immediate employment when Mrs. L died. Since she needed income to support her family, the aide filed for unemployment benefits. It was at that point, that the IRS became aware of the employer and filed a lawsuit for back unemployment taxes, penalties and a fine. The family of Mrs. L did not understand their responsibility as an employer and found themselves in a legal action that took over two years and many thousands of dollars to resolve.
Workers' Compensation and Liability Issues
As the employer, the individual or family paying for the private home health aide would be held liable for any work-related injury that occurs on the job. This can include the cost of all medical expenses and any disability payments that might become applicable.
Since the home-care industry is noted for work-related injuries, this can be a huge risk, especially if the caregiving tasks include lifting, transferring or bathing. There are also risks related to communicable diseases if the aide does not abide by universal precautions that are required by all licensed agency personnel.
Furthermore, the employer retains any liability that arises out of an injury to the person being cared for or any other person on the premises. If the home health aide were to cause an accident, for example, in which other family members suffered any harm or losses, the employer would bear the full responsibility for all costs and compensation.
Case Example: Home health aide, Myra Jones had a history of back injuries after many years of work in rehabilitation facilities. Her injuries always responded well to treatment, and were kept at bay with back supports provided by her employer. When Mrs. Jones had the opportunity to follow one of her clients home from rehab as a private aide, she took advantage of the offer and worked privately for Mr. S.
Mr. S didn't need a lot of physical care when he first left the rehab facility. He was there because he had had surgery that left him weak and a little confused. Unfortunately, the confusion did not clear up as the anesthesia left his body. It seemed that he had begun to develop a dementing illness, and would need increasing supervision for safety.
Over time, Mr. S began to need increasing amounts of physical care, especially for transferring and dressing. Mrs. Jones found herself increasingly taxed by the care of Mr. S, but she had become so attached to him that she did not express her concerns to the family that had hired her.
One day, as Mrs. Jones was dressing Mr. S, she bent down to help him with his shoes and her back froze in place. She was unable to straighten up. She managed to creep to the phone to call a friend for help, but she had to insist that Mr. S not move out of her sight for fear that he would wander off.
Mrs. Jones had found herself being treated in the rehabilitation facility in which she used to work. The doctor told her that she would not be able to work as an aide again. As she got stronger, Mrs. Jones filed for worker's compensation and disability insurance.
Once again, the government became aware of the employment situation in which the injury occurred and they pursued the family for medical expenses and for disability coverage. This cost the family many times more than it would have if they had the appropriate insurances or if they had worked through a licensed home health agency.
Abuse and Exploitation
Unfortunately, there is the potential for both physical abuse and financial exploitation when work is being done on behalf of a frail, functionally limited, and often cognitively impaired individual. While most individuals who become home health aides do so out of a desire to help others and to contribute to the community, there will always be those who see this type of work as an opportunity to take advantage of someone. This becomes especially easy when the aide and the recipient of care are isolated in a private home setting with little or no supervision.
Families don't fail to provide supervision out of malicious neglect. Supervision is often difficult because of geographic distance, lack of expertise, or the close emotional bonds that often get established between the aide and the person receiving the care. Furthermore, families often do not have the time or the resources to do criminal background checks, or to contact references, if they even think to ask for references. Sometimes families are so grateful for the care provided by an aide that they are also vulnerable to manipulation and exploitation.
Agency Supervision
A licensed home care agency has a responsibility to provide ongoing supervision for their employees. This includes helping the aides to understand the changing needs of clients, assuring the proper limits of care according to the practice acts of the various levels of professionals, and mediating difficult relationship issues.
Providing supervision is often as important for the aide as it is for the family. Home health aides often work with very challenging situations in the isolation of the private home situation. There are often issues of different cultural and faith traditions, different expectations about personal schedules, eating preferences and expectations. An agency supervisor can help to clarify the roles of the home health aide, and the expectations of both worker and care recipient. Furthermore, the agency can support the aide in setting appropriate limits on the types of care that can be provided. For example, an older adult might expect an aide to help with dressing changes or high tech care that is legally the responsibility of a licensed nurse.
In situations in which there are personality issues because of cognitive changes or a history of challenging relationships, the agency supervisor is available to provide guidance and support to both staff and care recipient. This can be very fragile, especially if there is a lack of trust or behaviors that are strange to the home health aide. The support of a supervisor can help the aide understand that this is part of the disease process and cope with behaviors so that the aide and the client can have a successful relationship. Often, supportive supervision is the key to making a challenging situation work.
Case Example: Mr. B lost his wife who had cared for him for over 60 years. He needed help with shopping, meal preparation, transportation and an appropriate selection of clothing. His family had hired many aides on his behalf. It seemed that Mr. B would fire every aide after only a few days, always stating that they didn't know how to do anything right. When Mr. B came to us, the home health supervising nurse spent time talking with him about his needs and expectations.
She learned that Mr. B was unhappy because none of the aides did things the way his wife had done them and this made him feel uncomfortable in his own home. The nurse supervisor explained that everyone had different ways of keeping house. Mr. B was amazed because he thought that all women learned the same routines. Having realized this, the nurse spent more time with Mr. B to find out what was happening that was different from what his wife had done. Amazingly, small things like letting dishes air dry on the counter, versus drying them and putting them away, were distressing to him. By going through the daily routine and learning about Mr. B's expectations, the supervisor was able to provide clarification to the aide and the first one placed in the home was able to be successful and have a multi-year relationship with Mr. B.
The employer, whether it is a private individual or an agency, has a great deal of responsibility in hiring and managing a home health aide. This includes responsibilities that are financial, legal and involve governmental regulations. When a family is ready to hire home health aide services, they need to make a basic decision about the source of such assistance. This decision needs to take into consideration the type of help needed, the financial and tax implications, the need for supervision and the relative vulnerability of the person receiving the care.
If the family is unwilling or unable to assume the full range of responsibilities, they would be better off working through an agency. If the family chooses to hire privately, they need to consult a lawyer and an accountant to assure that they make proper arrangements for all of their obligations. In addition, they need to stay involved in the relationship to assure proper care and a mutually supportive relationship.
Wednesday
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